Provider Demographics
NPI:1336418730
Name:POLOWCHAK, TANAGER YVONNE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:TANAGER
Middle Name:YVONNE
Last Name:POLOWCHAK
Suffix:
Gender:
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:10729 TOWN SQUARE DR NE STE 120
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-7923
Practice Address - Country:US
Practice Address - Phone:763-343-9010
Practice Address - Fax:763-343-9011
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC2804101YM0800X
MN2804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health